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Statins: Should I Take Them to Prevent a Heart Attack or Stroke?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Your options

Is this decision for you? This could be a decision for you if you do not have heart disease and have not had a stroke. If you have been diagnosed with heart disease or peripheral arterial disease (PAD) or if you have had a stroke, this information is not for you. Statins are strongly recommended for people with these conditions.

Key points to remember

Statins can help prevent heart disease and lower your risk of heart attack and stroke. The benefit is greatest for people at high risk of heart attack and stroke.

If you have a low risk of heart attack and stroke, you will get less benefit from taking a statin, so the decision may not be as clear.

You can work with your doctor to find out your risk of heart attack and stroke and decide if a statin might be right for you. Your risk is based on your cholesterol levels, your blood pressure, your age and gender, and other things, including whether you smoke.

Some people who take statins may have side effects, such as muscle aches.

A heart-healthy lifestyle is important to help lower your risk whether you take statins or not. This includes eating healthy foods, being active, staying at a healthy weight, and not smoking.

Your doctor can help you understand your risk of heart attack and stroke. Your doctor will use a few things to figure out your risk. These include:

Your cholesterol numbers.

Your blood pressure.

Whether you have diabetes.

Your age, gender, and race.

Whether you smoke.

Your doctor might talk about your risk of having a heart attack or a stroke in the next 10 years. There are different online tools that doctors can use to calculate this risk. These tools are not perfect. They may show that your risk is higher or lower than it really is. But the tools can give you and your doctor a good idea about your risk.

Your doctor is likely to recommend a statin if you are at high risk of heart attack or stroke. For example, you may be at high risk if you have diabetes and you smoke.

If you are not at high risk of heart attack or stroke, it may not be as clear that you will benefit from taking a statin. You and your doctor may think about certain things, like your family history of heart disease, to decide if medicine may be right for you.

In general:

People at high risk will get more benefit from taking a statin than those at low risk.

People at low risk will get less benefit from taking a statin. They may decide that a heart-healthy lifestyle is all they need to keep their risk low.

Cholesterol is a
type of fat in your blood. Your body needs it for many things, such
as making new cells. But if you have too much cholesterol, it starts to build up in
blood vessels called arteries. This problem is called atherosclerosis. It is the starting point for most heart and blood flow problems, including heart attacks and strokes.

Statins lower bad cholesterol by reducing how much of it your body makes. Statins also decrease inflammation around the cholesterol buildup (called a plaque). This may lower the risk that the plaque will break apart and cause a blood clot that can lead to a heart attack or stroke.

Statins sometimes cause
side effects. The most common one is muscle aches.

A less common side effect is diabetes. Statins may slightly raise the risk of diabetes in some people.

The decision to take a statin is up to you. You can try it, and if you don't like the way it makes you feel, you can change your mind. Most side effects, including muscle aches, will go away if you stop taking the medicine.

With statins, about 5 out of 100 people will get diabetes. This means that about 95 out of 100 won't.

Without statins, about 4 to 5 out of 100 people will get diabetes. This means that about 95 to 96 out of 100 won't.

Understanding the evidence

Some evidence is better than other evidence. Evidence comes from studies that look at how well treatments and tests work and how safe they are. For many reasons, some studies are more reliable than others.
The better the evidence is—the higher its quality—the more we can trust it.

Another thing to understand is that the evidence can't predict what's going to happen in your case. When evidence tells us that 2 out of 100 people who have a certain test or treatment may have a certain result and that 98 out of 100 may not, there's no way to know if you will be one of the 2 or one of the 98.

Compare your options

Compare

What is usually involved?

What are the benefits?

What are the risks and side effects?

Take statins to lower
your risk of heart attack or stroke Take statins to lower
your risk of heart attack or stroke

You take a pill every day.

You also have a heart-healthy lifestyle, which includes being active, eating healthy foods, staying at a healthy weight, and not smoking.

Studies show that statins can lower the risk of heart attack and stroke.

Statins provide the most benefit for people at high risk of heart attack and stroke.

Statins may cause
side effects, such as muscle aches.

Statins may slightly increase the risk of diabetes.

Don't take statins
Don't take statins

You have a heart-healthy lifestyle, which includes being active, eating healthy foods, staying at a healthy weight, and not smoking.

Healthy habits alone can help lower your
risk of heart attack and stroke without the possible side effects of medicine.

You avoid the bother and cost of taking a pill every day.

Healthy habits alone may not lower your risk as much as healthy habits plus a statin would.

Stories about deciding whether to take a statin to lower heart attack and stroke risk

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

I'm concerned about my risk of having a heart attack or stroke. So I talked with my doctor about some things that raise my risk, like having diabetes and being overweight. We decided that medicine would be a good idea for me. I'm also going to start getting more exercise and trying to lose some weight.

Becky, age 56

My cholesterol is high, but I really don't like
taking pills. My main risk factor is smoking. My doctor said quitting would help lower my risk. So I'm going to work with him to see if I can finally quit smoking for good.

Diego, age
41

My mom died of a heart attack when she was
in her 50s. My doctor calculated my risk, and it is right on the border between moderate and high. But still it worries me because of my mom. My doctor said a statin could help lower my heart attack risk, so I am going to take
the medicine.

Charles, age
48

I just had a cholesterol test and found out that my cholesterol is high. But my blood pressure and some other things are fine. I don't smoke. So my doctor and I talked about it. She said I can try to eat better and get more exercise and see if that lowers my risk.

Carole, age
58

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to take statins

Reasons not to take statins

I'm worried about my risk of heart attack and stroke, and I want to do everything I can to reduce it.

I'm not very worried about my risk of heart attack and stroke.

More important

Equally important

More important

I don't mind taking medicine if it will reduce my risk of heart attack and stroke.

I hate the idea of taking a pill every day.

More important

Equally important

More important

I'm not worried about the side effects of these medicines.

I am worried about the side effects of these medicines.

More important

Equally important

More important

I'm already doing everything I can to reduce my risk through heart-healthy habits.

I could do more to reduce my risk by improving my habits.

More important

Equally important

More important

My other important reasons:

My other important reasons:

More important

Equally important

More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Taking statins

NOT taking statins

Leaning toward

Undecided

Leaning toward

What else do you need to make your decision?

Check the facts

1.1, Do statins benefit people at low risk of heart attack or stroke as much as people at high risk?

YesSorry, that's not right. Statins provide the greatest benefit for people at high risk of heart attack and stroke.

NoYou're right. Statins provide the greatest benefit for people at high risk of heart attack and stroke.

I'm not sureIt may help to go back and read "Get the Facts." Statins provide the greatest benefit for people at high risk of heart attack and stroke.

2.2, Do you still need healthy habits even if you take a statin medicine?

YesYou're right. Even if you take a statin, you will still need healthy habits, such as eating heart-healthy foods, losing weight if you need to, exercising, and not smoking.

NoSorry, that's not right. Even if you take a statin, you will still need healthy habits, such as eating heart-healthy foods, losing weight if you need to, exercising, and not smoking.

I'm not sureIt may help to go back and read "Get the Facts." Even if you take a statin, you will still need healthy habits, such as eating heart-healthy foods, losing weight if you need to, exercising, and not smoking.

3.3, Do statins cause side effects?

YesYou're right. Statins may cause side effects. Muscle aches are a common one.

NoSorry, that's not right. Statins may cause side effects. Muscle aches are a common one.

I'm not sureIt may help to go back and read "Get the Facts." Statins may cause side effects. Muscle aches are a common one.

Goff DC Jr, et al. (2013). 2013 ACC/AHA guideline on the assessment of cardiovascular risk: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation, published online November 12, 2013. DOI: 10.1161/01.cir.0000437741.48606.98. Accessed November 22, 2013.

Smith SC, et al. (2011). AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update: A guideline from the American Heart Association and American College of Cardiology Foundation. Circulation, 124(22): 2458–2473. Also available online: http://circ.ahajournals.org/content/124/22/2458.full.

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Statins: Should I Take Them to Prevent a Heart Attack or Stroke?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Get the facts

Compare your options

What matters most to you?

Where are you leaning now?

What else do you need to make your decision?

1. Get the Facts

Your options

Start taking a medicine called a statin to help prevent heart disease and lower your risk of heart attack and stroke.

Is this decision for you? This could be a decision for you if you do not have heart disease and have not had a stroke. If you have been diagnosed with heart disease or peripheral arterial disease (PAD) or if you have had a stroke, this information is not for you. Statins are strongly recommended for people with these conditions.

Key points to remember

Statins can help prevent heart disease and lower your risk of heart attack and stroke. The benefit is greatest for people at high risk of heart attack and stroke.

If you have a low risk of heart attack and stroke, you will get less benefit from taking a statin, so the decision may not be as clear.

You can work with your doctor to find out your risk of heart attack and stroke and decide if a statin might be right for you. Your risk is based on your cholesterol levels, your blood pressure, your age and gender, and other things, including whether you smoke.

Some people who take statins may have side effects, such as muscle aches.

A heart-healthy lifestyle is important to help lower your risk whether you take statins or not. This includes eating healthy foods, being active, staying at a healthy weight, and not smoking.

FAQs

How can you know your risk of heart attack and stroke?

Your doctor can help you understand your risk of heart attack and stroke. Your doctor will use a few things to figure out your risk. These include:

Your cholesterol numbers.

Your blood pressure.

Whether you have diabetes.

Your age, gender, and race.

Whether you smoke.

Your doctor might talk about your risk of having a heart attack or a stroke in the next 10 years. There are different online tools that doctors can use to calculate this risk. These tools are not perfect. They may show that your risk is higher or lower than it really is. But the tools can give you and your doctor a good idea about your risk.

Why might your doctor recommend taking a statin?

Your doctor is likely to recommend a statin if you are at high risk of heart attack or stroke. For example, you may be at high risk if you have diabetes and you smoke.

If you are not at high risk of heart attack or stroke, it may not be as clear that you will benefit from taking a statin. You and your doctor may think about certain things, like your family history of heart disease, to decide if medicine may be right for you.

In general:

People at high risk will get more benefit from taking a statin than those at low risk.

People at low risk will get less benefit from taking a statin. They may decide that a heart-healthy lifestyle is all they need to keep their risk low.

What lifestyle changes can lower your risk of heart attack or stroke?

Everyone can help lower their risk with a heart-healthy lifestyle. This includes:

Eating a heart-healthy diet that is rich in fruits, vegetables, whole grains, fish, and healthy fats.

How do statins work?

Cholesterol is a
type of fat in your blood. Your body needs it for many things, such
as making new cells. But if you have too much cholesterol, it starts to build up in
blood vessels called arteries. This problem is called atherosclerosis. It is the starting point for most heart and blood flow problems, including heart attacks and strokes.

Statins lower bad cholesterol by reducing how much of it your body makes. Statins also decrease inflammation around the cholesterol buildup (called a plaque). This may lower the risk that the plaque will break apart and cause a blood clot that can lead to a heart attack or stroke.

What are the side effects of statins?

Statins sometimes cause
side effects. The most common one is muscle aches.

A less common side effect is diabetes. Statins may slightly raise the risk of diabetes in some people.

The decision to take a statin is up to you. You can try it, and if you don't like the way it makes you feel, you can change your mind. Most side effects, including muscle aches, will go away if you stop taking the medicine.

What do numbers tell us about benefits and risks of statins?

Benefits

Number of people who will have a heart attack or stroke in the next 10 years by risk level*

Risk of heart attack or stroke

With statins

Without statins

Low risk

2 out of 100

3 out of 100

Moderate risk

8 out of 100

10 out of 100

High risk

15 out of 100

20 out of 100

* These numbers are estimates based on research studies. The quality of the evidence is high1

Evidence shows that statins may lower the chance of having a heart attack or stroke, especially for people who are at high risk.

With statins, about 5 out of 100 people will get diabetes. This means that about 95 out of 100 won't.

Without statins, about 4 to 5 out of 100 people will get diabetes. This means that about 95 to 96 out of 100 won't.

Understanding the evidence

Some evidence is better than other evidence. Evidence comes from studies that look at how well treatments and tests work and how safe they are. For many reasons, some studies are more reliable than others.
The better the evidence is—the higher its quality—the more we can trust it.

The information shown here is based on the best available evidence.1, 2, 3

Another thing to understand is that the evidence can't predict what's going to happen in your case. When evidence tells us that 2 out of 100 people who have a certain test or treatment may have a certain result and that 98 out of 100 may not, there's no way to know if you will be one of the 2 or one of the 98.

2. Compare your options

Take statins to lower
your risk of heart attack or stroke

Don't take statins

What is usually involved?

You take a pill every day.

You also have a heart-healthy lifestyle, which includes being active, eating healthy foods, staying at a healthy weight, and not smoking.

You have a heart-healthy lifestyle, which includes being active, eating healthy foods, staying at a healthy weight, and not smoking.

What are the benefits?

Studies show that statins can lower the risk of heart attack and stroke.

Statins provide the most benefit for people at high risk of heart attack and stroke.

Healthy habits alone can help lower your
risk of heart attack and stroke without the possible side effects of medicine.

You avoid the bother and cost of taking a pill every day.

What are the risks and side effects?

Statins may cause
side effects, such as muscle aches.

Statins may slightly increase the risk of diabetes.

Healthy habits alone may not lower your risk as much as healthy habits plus a statin would.

Personal stories

Stories about deciding whether to take a statin to lower heart attack and stroke risk

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"I'm concerned about my risk of having a heart attack or stroke. So I talked with my doctor about some things that raise my risk, like having diabetes and being overweight. We decided that medicine would be a good idea for me. I'm also going to start getting more exercise and trying to lose some weight."

— Becky, age 56

"My cholesterol is high, but I really don't like taking pills. My main risk factor is smoking. My doctor said quitting would help lower my risk. So I'm going to work with him to see if I can finally quit smoking for good."

— Diego, age
41

"My mom died of a heart attack when she was in her 50s. My doctor calculated my risk, and it is right on the border between moderate and high. But still it worries me because of my mom. My doctor said a statin could help lower my heart attack risk, so I am going to take the medicine."

— Charles, age
48

"I just had a cholesterol test and found out that my cholesterol is high. But my blood pressure and some other things are fine. I don't smoke. So my doctor and I talked about it. She said I can try to eat better and get more exercise and see if that lowers my risk."

— Carole, age
58

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to take statins

Reasons not to take statins

I'm worried about my risk of heart attack and stroke, and I want to do everything I can to reduce it.

I'm not very worried about my risk of heart attack and stroke.

More important

Equally important

More important

I don't mind taking medicine if it will reduce my risk of heart attack and stroke.

I hate the idea of taking a pill every day.

More important

Equally important

More important

I'm not worried about the side effects of these medicines.

I am worried about the side effects of these medicines.

More important

Equally important

More important

I'm already doing everything I can to reduce my risk through heart-healthy habits.

I could do more to reduce my risk by improving my habits.

More important

Equally important

More important

My other important reasons:

My other important reasons:

More important

Equally important

More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Taking statins

NOT taking statins

Leaning toward

Undecided

Leaning toward

5. What else do you need to make your decision?

Check the facts

1.
Do statins benefit people at low risk of heart attack or stroke as much as people at high risk?

Yes

No

I'm not sure

You're right. Statins provide the greatest benefit for people at high risk of heart attack and stroke.

2.
Do you still need healthy habits even if you take a statin medicine?

Yes

No

I'm not sure

You're right. Even if you take a statin, you will still need healthy habits, such as eating heart-healthy foods, losing weight if you need to, exercising, and not smoking.

3.
Do statins cause side effects?

Yes

No

I'm not sure

You're right. Statins may cause side effects. Muscle aches are a common one.

Decide what's next

1.
Do you understand the options available to you?

Yes

No

2.
Are you clear about which benefits and side effects matter most to you?

Yes

No

3.
Do you have enough support and advice from others to make a choice?

Goff DC Jr, et al. (2013). 2013 ACC/AHA guideline on the assessment of cardiovascular risk: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation, published online November 12, 2013. DOI: 10.1161/01.cir.0000437741.48606.98. Accessed November 22, 2013.

Smith SC, et al. (2011). AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update: A guideline from the American Heart Association and American College of Cardiology Foundation. Circulation, 124(22): 2458–2473. Also available online: http://circ.ahajournals.org/content/124/22/2458.full.

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